PLEASE DO NOT SUBMIT THIS FORM IF YOU
ARE NOT AN NHS EMPLOYEE
OR AN NHS GOLD CARD HOLDER

Invalid Registrations will be rejected
automatically
Work Email/NHS Email:
Private Email:
Title:
First Name:
Last Name:
Home Address:
Post Code:
Telephone No:
Mobile:
Your first medical Gold Privilege Card No /
Code you have been issued by first medical:
Your NHS ID Card No and Issue Date (If you
do not have a fm NHS Privilege Card yet):

RECOMMENDATIONS:
List names of any local companies or
establishments (restaurants, hairdressers,
ladieswear, florists, solicitors etc.) that
you would like to receive discounts from:
Job Title:
Date of Birth:
Work Address:
Work Tel No:

Thank
you for registering with
DiscountsHealthService.com. Your username
and password will be forwarded to you upon
verification of your submitted application.